Arm pain may cause weakness of movement in a part of the arm as well as numbness or pins and needles, which are also felt in the arm or hand. There is often neck pain associated if the pain arises from the spine. Here, one of our top neurosurgeons Mrs Anne Mitchener explains the common causes of arm pain and when it might be time to see a specialist.
What are the common causes of arm pain?
Injuries to any part of the arm from shoulder to fingers can, of course, cause arm pain as can systemic diseases, such as arthritis or peripheral vascular disease.
With regard to the spine, however, we refer to the pain as ‘brachalgia’ when a pinched or trapped nerve in the spinal canal is the cause of pain referred to or felt in the arm. This may or may not be associated with neck pain. This may be traumatic or spontaneously arising.
But the commonest cause is the degenerate change in the discs in particular, which dry out with age and prolapse or bulge towards the spinal cord itself, or to the side more commonly where they compress the nerve to one arm or the other.
The bones also remodel over time with wear and small spicules form called osteophytes, which can comprise the nerves as well by narrowing the bony tunnel the nerves travel in from spine to arm. Ligaments which thicken with age also can add to nerve compression. Occasionally there is laxity in movement between the vertebrae as they flex and extend and this allows the vertebrae to slip upon each other also comprising the cord or nerves.
Peripheral nerves such as the median at the wrist and the ulna at the elbow can become trapped and inflamed. This does not involve the spine.
Uncommonly patients have brachial plexus injuries or tumours that are usually benign growing on the nerves in the plexus. The plexus represents all the nerves leaving the spinal cord that are travelling to the arm.
What are risk factors of causing arm pain?
The commonest cause of arm pain is trauma and wear and tear or degeneration of tissues over time. This relates to spinal causes of arm pain and to systemic e.g. arthritis, peripheral vascular disease, tennis and golfers elbow etc. Severe traumatic injury to the spine can occur from diving accidents and contact sports.
The consequence can be confined to arm pain unilateral or bilateral. Whiplash injuries are common and can cause similar significant injury, or milder symptoms that are self-limiting.
Repetitive movements such as while working at a screen with neck flexed or extended for long periods can lead to symptoms from the spine. Recently, consideration has been given to the use of mobile phones and the likelihood that the frequent flexed position of the neck will lead to neck symptoms and possibly arm pain.
When would I need to see a specialist?
If the symptoms persist, despite consultation with your GP, it may be sensible to request to see a specialist. Certainly, if there is weakness or numbness in the arm it is important to have the cause diagnosed as quickly as possible. If the pain keeps you awake it needs to be investigated sooner.
How is arm pain diagnosed and treated?
The diagnosis is made by taking a clinical history and examining the arm. Thereafter blood tests may be appropriate, plain X-rays or a scan. If spinal pathology is expected, an MRI is the scan of choice but CT scans are also used where necessary or for more information about the bones.
Conservative treatment is usually tried first and indeed may be all that is indicated. It commences with medication if appropriate, physiotherapy often is added early and steroid injection will be considered if appropriate to the investigative findings to reduce inflammation and therefore pain.
As a last resort, surgical options would be considered and offered if appropriate to the diagnosis. Decompressive surgery is the most often undertaken, sometimes involving a fusion of one vertebra to the next.
Do not hesitate now to book an appointment with Mrs Mitchener if you have persistent arm pain.